Cm In Patients Research Articles

Human Demodex mites (Acari: Demodicidae) as a possible etiological factor in Rosacea: A cross-sectional study from Turkey

This study was conducted to determine the prevalence and burden of Demodex mites in patients with rosacea, and to investigate their potential contribution to the aetiology of rosacea. The study included 82 patients (44 with papulopustular rosacea and 38 with erythematotelangiectatic rosacea) diagnosed with rosacea by clinical examination and 82 healthy controls without dermatologic disease. Samples were obtained from each participant from the cheek, nasolabial, and chin regions using standardised skin surface biopsy (SSSB). Samples were examined under a light microscope, and Demodex species were identified and counted. Demodex positivity (≥5 mites) was detected in 91% of patients and 20% of controls in the study (p< 0.01). Only D. folliculorum (total 1328, mean 44.27/cm2) was detected in 37% of patients and D. folliculorum + D. brevis coinfection (total 6071, mean 134.91/cm2) in 55% of patients. Only D. folliculorum (total 97, mean 6.06/cm2) was detected in 20% of healthy controls, while D. folliculorum + D. brevis co-infection was not detected. The study showed that Demodex burden in patients with rosacea was approximately 30 times higher than in healthy controls and was caused by coinfection of D. folliculorum and D. brevis (mean Demodex burden: 179.18/cm2 in patients, 6.06/cm2 in healthy controls). It was concluded that Demodex infestation, especially co-infection with D. folliculorum and D. brevis, may be a potential factor in the aetiology of rosacea that should not be ignored in the clinic, and that it may be appropriate to initiate antiparasitic treatment when the parasite is detected.

Comparison of Arthroscopic Microfracture and Retrograde Subchondral Drilling in the Treatment of Osteochondral Lesions of Talus.

In our study, it was aimed to evaluate the efficacy of microfracture and retrograde subchondral drilling on clinical outcomes in patients who underwent ankle arthroscopy due to osteochondral lesion of medial talus. Twenty eight patients with osteochondral lesion of talus less than 1.5 cm2 treated with ankle arthroscopy were evaluated retrospectively. Microfracture was performed in 16 patients and retrograde subchondral drilling was performed in 12 patients that there was no loss of integrity in the cartilage layer or cartilage layer is partially preserved during ankle arthroscopy. Postoperative evaluations of the patients were done with Foot and Ankle Ability Measure (FAAM) and results of both group were compared statistically. The mean activities of daily living scale was 93.4±3.2 and sportive activity scale was 90.1±5.7 in the retrograde drilling group. In the micro-fracture group, mean activities of daily living scale was 93.8±4.1 and mean sportive activity scale was 88.9±9.5. No significant difference was found as a result of statistical comparisons of both groups results. It has been determined that the size and preservation of the integrity of talar osteochondral lesions are important factors on clinical results. Results of arthroscopic debridement, microfracture and drilization are not good in lesions larger than 1.5 cm2 and lesions with impaired integrity. In our study, depending on the general literature, osteochondral lesions in talus were less than 1.5 cm2 in patients who underwent arthroscopic micro fracture and retrograde drilling. Both microfracture and retrograde subchondral drilling are effective treatment methods with good clinical results for talar osteochondral lesions less than 1,5cm2 . Retrograde subchondral drilling can be an alternative treatment method with the reliability of clinical results in patients with no loss of the integrity of the cartilage layer or cartilage layer is partially preserved. talus, osteochondral lesion, microfracture, subchondral drilling.

Radiation doses in endovascular revascularisation of lower-extremity arterial diseases.

The use of percutaneous endovascular intervention in lower-extremity arterial diseases is increasing daily. With the growing technical experience of vascular surgeons, this is preferred to open surgery in more complex lesions. The dose area product (DAP) and fluoro (FL) time values of 150 patients who underwent successful peripheral endovascular arterial intervention were analysed retrospectively. These values were evaluated by grouping according to the anatomical region and complexity of the lesion, type of procedure and arterial access. While the mean DAP was 18 ± 27 Gy cm2 in patients who underwent only angioplasty, it was 21 ± 17 Gy cm2 in patients who underwent stent implantation after angioplasty ( p = 0.069). The DAP value was statistically significantly higher in patients who had intervention in the pelvic region, both in the angioplasty (23 ± 22 Gy cm2) group and in the stenting (29 ± 18 Gy cm2) group, than in patients who had intervention in the femoropopliteal region (18 ± 27 and 15 ± 12 Gy cm2, respectively) (p < 0.05). When the correlation between body mass index (BMI) of the patients and DAP was examined, a moderate positive correlation was found both in the pelvic region (r = 0.601, p = 0.00) and in the femoropopliteal region (r = 0.512, p = 0.00). Out of 78 patients in whom the ipsilateral popliteal retrograde approach was preferred, only two developed arteriovenous fistulae after the procedure, and only two of 77 patients in whom the femoral approach was preferred developed no major or minor complications, except femoral pseudo-aneurysm. The most important factors affecting the radiation doses of the patients were the anatomical region and the patient's BMI. Radiation doses were higher in pelvic interventions compared to the femoropopliteal region. This may encourage the choice of arterial approaches that can minimise visualisation of the pelvic region in particular. Therefore, attention should be paid to pre-operative planning, especially in patients undergoing multiple diagnostic and therapeutic imaging. The ipsilateral popliteal retrograde approach can be safely chosen in combined iliofemoral, common femoral and superficial femoral total occlusions in the hands of surgeons with good Doppler ultrasonography experience.

Cardiac 18F‑FDG uptake and new‑onset rectal cancer.

The present study aimed to investigate the factors affecting the cardiac uptake of 18F-fluorodeoxyglucose (18F-FDG) during 18F-FDG positron emission tomography (PET) for new-onset rectal cancer and new-onset colon cancer (ascending, transverse, descending, sigmoid colon cancer) and to examine the association between the cardiac uptake of 18F-FDG and prognosis. The participants were diagnosed with new-onset rectal cancer and new-onset colon cancer (ascending, transverse, descending, sigmoid cancer) at the Iga City General Hospital (Iga, Japan) between January 1, 2013, and March 31, 2018, and underwent an 18F-FDG PET scan for pretreatment staging. The relationship between cardiac maximum standard uptake value (SUVmax), the presence/absence of distant metastasis and prognosis was examined. A total of 26 patients (14 men and 12 women) aged 72.0±10 years with new-onset rectal cancer were selected for the study. No patients had multiple simultaneous cancers. The median cardiac SUVmax was 3.8 and 2.5 in patients with no distant metastasis and distant metastasis, respectively, revealing a statistically significant difference (P<0.01). The median tumor volume on PET-computed tomography (CT) images was 7,815 cm2 and was 66,248 cm2 in patients with no distant metastasis and distant metastasis, respectively, revealing a statistically significant difference (P<0.01). Echocardiography findings revealed no significant difference between patients with and without distant metastasis. The correlation coefficient between cardiac SUVmax and total tumor volume on PET/CT images (primary + lymph + distant metastases) was statistically significant (r=-0.42, P=0.03). Analysis of the association between the occurrence of distance metastasis and cardiac SUVmax as a continuous variable gave a statistically significant result [hazard ratio (HR): 0.30, 95% confidence interval (CI): 0.09-0.98, P=0.045]. Receiver operating characteristic analysis showed a cardiac SUVmax of 2.6 with an area under the curve of 0.86 for determining the presence of distant metastasis (95% CI: 0.70-1.00). The median observation time was 56 months, and nine patients died during observation. Analysis of the association between the overall survival and cardiac SUVmax (cutoff: 2.6) showed 95% CI: 0.01-0.45 and HR: 0.06 (P<0.01); that between the overall survival and total tumor volume on PET images showed 95% CI: 1.00-1.00 and HR: 1.00 (P<0.01); and that between the overall survival and presence of distant metastasis showed 95% CI: 1.72-116.4 and HR: 14.1 (P<0.01). Furthermore, 25 patients (16 men and nine women) aged 71.4±14.2 years with new-onset colon cancer were selected for the study. Analysis of new-onset colon cancer revealed no statistically significance between the cardiac SUVmax and distant metastasis.

A comparative study of the outcomes of endoscopic septoplasty with conventional septoplasty

Background Deviated nasal septum is common problem in otolaryngorhinological practice. This study was mainly undertaken to compare the advantages and disadvantages of endoscopic septoplasty over conventional septoplasty. Material and methods A prospective study was undertaken in 60 patients attending ENT OPD in a tertiary care centre. The sample was selected by using non-probability convenient sampling technique. Equal number of patients were randomly allocated in to endoscopy and conventional groups by double blinding method. Preoperative nasal obstruction symptom score was noted and intraoperative time was noted in minutes. Al the patients received pe medication and operated adhering to strict protocol. The patients were followed at weekly interval for complications and success rates. Results The mean age of the patients was 27 years and majority of the patients were males. Nasal blockage was the common symptom in the study group. The nasal airflow improved to 4 – 5 cm2 in patients of both the groups. The mean duration of the surgery was 60.37 minutes in endoscopic group and 54.07 minutes in conventional group. Unilateral mucosal tear was the common intraoperative complication and was seen more in conventional group than the endoscopic group.

Sinking skin syndrome in a decompressive craniectomy series: Clinical and radiological features.

The sinking skin syndrome (SSS) is a particular complication after a decompressive craniectomy (DC). It still remains a poorly understood and underestimated entity. Retrospective case series of craniectomized patients with and without SSS. Clinical and radiological features (DC diameter, shape of craniectomy flap, and midline deviation) were described and relative volumes of intracranial loss were quantified. Twenty-seven patients (63% with SSS). The most common indication for DC was traumatic brain injury: 48.15%. The p50 diameter of DC was 12.8 cm for patients with SSS and 11.1 cm for patients without (Z score = 0.32). DC area was 81.5 cm2 for patients with SSS and 71.43 cm2 for patients without the syndrome (Z score = 0.61). According to the shape of the craniectomy flap, we classified our patients as: «same level» (51.8%), «sunken» (25.9%), and «extracranial herniation» (14.8%). Two patients (7.4%) had paradoxical herniation. Midline deviation was present in 12 (70.6%) patients with SSS. The 3rd ventricle volume average was 1.2 cc for patients with SSS versus 2.35 cc for patients without (Z score = 0.04). About 94.11% of patients (16 out of 17) clearly improved after replacement of the cranial defect. In our series, low 3rd ventricle volumes had a good relation with SSS. The presence of a sunken flap does not guarantee SSS per se and we propose the following radiologic description: A = sunken, B = same level, C = extracranial herniation, and D = paradoxical. Replacement of the skull defect is the main treatment.

Bi-atrial characterization of the electrical substrate in patients with atrial fibrillation.

BackgroundLittle is known regarding the characterization of electrical substrate in both atria in patients with atrial fibrillation (AF).MethodsEight consecutive patients undergoing AF ablation (five paroxysmal, three persistent) underwent electrical substrate characterization during sinus rhythm. Mapping of the left (LA) and right atrium (RA) was performed with the use of the HD Grid catheter (Abbott). Bipolar voltage maps were analyzed to search for low voltage areas (LVA), the following electrophysiological phenomena were assessed: (1) slow conduction corridors, and (2) lines of block. EGMs were characterized to search for fractionation. Electrical characteristics were compared between atria and between paroxysmal versus persistent AF patients.ResultsIn the RA, LVAs were present in 60% of patients with paroxysmal AF and 100% of patients with persistent AF. In the LA, LVAs were present in 40% of patients with paroxysmal AF and 66% of patients with persistent AF. The areas of LVA in the RA and LA were 4.8±7.3 cm2 and 7.8±13.6 cm2 in patients with paroxysmal AF versus 11.7±3.0 cm2 and 2.1±1.8 cm2 in patients with persistent AF. In the RA, slow conduction corridors were present in 40.0% (paroxysmal AF) versus 66.7% (persistent AF) whereas in the LA, slow conduction corridors occurred in 20.0% versus 33.3% respectively (p = ns). EGM analysis showed more fractionation in persistent AF patients than paroxysmal (RA: persistent AF 10.8 vs. paroxysmal AF 4.7%, p = .036, LA: 10.3 vs. 4.1%, p = .108).ConclusionBi‐atrial involvement is present in patients with paroxysmal and persistent AF. This is expressed by low voltage areas and slow conduction corridors whose extension progresses as the arrhythmia becomes persistent. This electrophysiological substrate demonstrates the important interplay with the pulmonary vein triggers to constitute the substrate for persistent arrhythmia.

Body Mass Index impact on Extended Total Extraperitoneal Ventral Hernia Repair: a comparative study.

Obesity is a risk factor for developing abdominal wall hernias and is associated with major postoperative complications, such as surgical site infection, delayed wound healing and recurrent hernia. Therefore, treating incisional hernia in this patient subgroup is a challenge. We conducted a comparative, prospective study on patients who underwent primary ventral hernia surgery or incisional hernia surgery through the extended totally extraperitoneal pathway, with body mass indices (BMIs) ≤ 30 (no obesity) and BMI > 30 (with obesity). We collected demographic data, preoperative and intraoperative variables, complication and recurrence rate, hospital stay and follow-up as postoperative data. From May 2018 to December 2020, 74 patients underwent this surgery, 38 patients without obesity and 36 with obesity. The median area of the hernia defect measured by CT was 57 cm2 and 93 cm2 in patients without and with obesity, respectively (p = 0.012). The median follow-up was 16months. One patient without obesity experienced some postoperative complication compared with four patients with obesity (p > 0.05). No patient without obesity had recurrent hernia compared with two patients with obesity (p > 0.05). There were statistically significant differences between patients with and without obesity in the size of the hernia defect. However, there were no significant differences in terms of complications, hospital stay, postoperative pain or relapses. Therefore, the minimally invasive completely extraperitoneal approach for patients with obesity appears to be a safe procedure despite our study limitations. Studies with longer follow-ups and a greater number of patients are needed.

Age and impaired left atrial performance are associated with increased atrial fibrosis in patients with paroxysmal and persistent atrial fibrillation

Abstract Background Atrial performance assessed by strain imaging is used as a surrogate for left atrial (LA) structural remodelling. Presence of low voltage zones (LVZs) detected by three-dimensional electroanatomical mapping in patients with atrial fibrillation (AF) denotes more expressed extrapulmonary substrate potentially leading to worse outcomes following pulmonary vein isolation (PVI) for the treatment of AF. Purpose The current study aims to investigate the association between strain imaging parameters from echocardiography and the presence and extent of LVZs derived from LA electroanatomical mapping in patients undergoing AF ablation. Methods Seventy-eight patients (58 males, 74%) aged 59±9.48 years undergoing PVI for paroxysmal (35 patients, 49%) or persistent AF were prospectively studied. Preprocedural echocardiography included LA strain imaging assessing global LA strain (LAS) and regional strain of the basolateral region (RSLB). During the procedure, LA electroanatomical mapping during paced atrial rhythm was performed in all patients obtaining a LA voltage map. All LA maps were analysed offline using a custom-made software calculating the zone of low bipolar voltage &amp;lt;0.5 mV (LVZ&amp;lt;0.5mV) and the total LA endocardial area excluding pulmonary veins antra. LVZ&amp;lt;0.5mv was expressed as an absolute value and as percentage of the whole LA area. Results Patients aged more than 65 years (N=21, 27%) demonstrated a larger area of LVZ&amp;lt;0.5mV: 25.5±17.8 cm2 vs. 9.4±10.6 cm2 in those younger than 65 years, P=0.001. This corresponded to a higher proportion of the LA area demonstrating LVZ&amp;lt;0.5mV in patients older than 65 years: 22.6±14.6% vs. 8.9±11.8% in those younger than 65 years, P&amp;lt;0.0001. Twenty-nine of 78 patients (37.1%) had preprocedural LAS&amp;lt;20% and 23 (29.5%) demonstrated RSLB of &amp;lt;21%. Patients with LAS &amp;lt;20% had a higher total LVZ&amp;lt;0.5mV: 20.3±16.6 cm2 vs. 9.8±12.1 cm2 in patients with LAS≥20% at baseline, P=0.004. This equaled to 17.7±15.6% vs. 9.5±11.9% of total LA area, respectively (P=0.011). Patients with RSLB&amp;lt;21% also demonstrated larger areas of LVZ&amp;lt;0.5mV in the LA: 21.6±17.9 cm2 vs. 10.39±11.83 cm2 in the patients with RSLB ≥21%, P=0.012. Expressed as a proportion of the whole LA area the difference remained significant: 18.8±17.1% vs. 9.9±11.6%, respectively P=0.01. Conclusion Older age and impaired LA performance assessed by LA strain imaging are associated with larger areas of LVZ&amp;lt;0.5mV possibly reflecting more expressed LA fibrotic changes in patients with paroxysmal and persistent AF. These findings might serve in the preprocedural selection of the patients undergoing catheter ablation of AF. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Bulgarian Society of Cardiology

Surface Area of Decompressive Craniectomy Predicts Bone Flap Failure after Autologous Cranioplasty: A Radiographic Cohort Study.

Skull bone graft failure is a potential complication of autologous cranioplasty after decompressive craniectomy (DC). Our objective was to investigate the association of graft size with subsequent bone graft failure after autologous cranioplasty. This single-center retrospective cohort study included patients age ≥18 years who underwent primary autologous cranioplasty between 2010 and 2017. The primary outcome was bone flap failure requiring graft removal. Demographic, clinical, and radiographic factors were recorded; three-dimensional (3D) reconstructive imaging was used to perform accurate measurements. Univariate and multi-variate regression analysis were performed to identify risk factors for the primary outcome. Of the 131 patients who underwent primary autologous cranioplasty, 25 (19.0%) underwent removal of the graft after identification of bone flap necrosis on computed tomography (CT); 16 (64%) of these were culture positive. The mean surface area of craniectomy defect was 128.5 cm2 for patients with bone necrosis and 114.9 cm2 for those without bone necrosis. Linear regression analysis demonstrated that size of craniectomy defect was independently associated with subsequent bone flap failure; logistic regression analysis demonstrated a defect area >125 cm2 was independently associated with failure (odds ratio [OR] 3.29; confidence interval [CI]: 0.249-2.135). Patient- and operation-specific variables were not significant predictors of bone necrosis. Our results showed that increased size of antecedent DC is an independent risk factor for bone flap failure after autologous cranioplasty. Given these findings, clinicians should consider the increased potential of bone flap failure after autologous cranioplasty among patients whose initial DC was >125 cm2.

Real-time 3D, 2D trans esophageal echocardiography for the evaluation of rheumatic mitral stenosis initial single center experience

Abstract : Mitral stenosis (MS) is one form of heart disease of a valvular nature. Narrowing of the mitral valve orifice occurs in the Mitral stenosis. The most common cause of MS is rheumatism fever. Other uncommon causes of MS are calcification of the mitral valve leaflets, congenital heart disease, infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis. The study aims to determine the consistency and viability of using 3dimensional transthoracic echocardiography 3DTEE planimetry (MVA 3D) for mitral valve area (MVA) dimensions in patients that have rheumatic mitral stenosis (RhMS). : A cross-sectional study with analytic elements. The data collection was carried out in the Shahid Al- Mihrab outpatient department. Forty-one patient patients underwent Transesophageal echo (TEE) to eliminate atrial thrombi in the left side, referring to our outpatient department for echocardiographic examination and evaluation of RhMS and suitability for percutaneous mitral valvoplasty (PTMV). The investigator and administrator arranged a self-restricted survey form to collect data from the members by straight meeting with participants. Forty-one patients had MS due to rheumatic heart disease (RhHD), where all (100%) assess MVA measurement by 3DTEE. It was significantly low if compare with mitral valve area by transthorasic echo planimetry (MVA TTE planimetry), mitral valve area by transthorasic echo (MVATTEPHT). However, mitral valve area by continuity equation by transthoracic echo (MVAconTTE) measurement was feasible in 5 patients only (12%), were no significant correlation between them. Mitral valve area by transesophageal echo,3dimension (MVA3DTEE) the best agreement with MVA2DTTE PLANEIMETRY was demonstrated (95 percent agreement limits and then with MVAPHTTTE (95 percent agreement limits. The mean ± SD of MVA3D TEE was 1.06 ± 0.79 cm2 in patients with minimal fusion, the mean ± SD of MVA3DTEE was 0.79±0.21 cm2, in patients with partial fusion, and the mean ± SD of MVA3D TEE was 0.69 ± 0.15 cm2 with complete fusion. There was a significant difference in the mean MVA3D TEE among the different degrees of fusions by 3D TEE (p=0.02). Three-dimensional (3D) TEE echocardiography has demonstrated accuracy for measuring MV area for both calcific also improved the “description” of valve anatomy, and provided an advantage for less experienced operators as a method for MV area measurements.

Do Hematologic Cancers Increase the Frequency of Demodex Spp.

Background and aim: Demodicosis is a parasitic skin disease caused by D. folliculorum and D. brevis, and is also known as hair follicle mite. The aim of this study was to determine the prevalence of D. folliculorum and D. brevis in hematologic cancer patients and to investigate their relation with chemotherapy. Materials and methods: Sixty-six hematologic cancer patients and 60 healthy individuals with similar age and sex were included in the study. Of the patients with hematological cancer, 50 received chemotherapy and 16 did not receive chemotherapy. The demographic characteristics of the patients were noted. Samples were taken from the cheeks, nose, chin and forehead of the participants with standardized skin surface biopsy and examined in light microscopy at 40x and 100x magnifications to determine the mite density in cm2. Demodicosis was assessed as positive if 5 or more Demodex spp. were seen per cm2. Results: Demodex spp. was positive in 19 (28.78%) of the cancer patients and 3 (5%) of the control group. The prevalence of Demodex spp. was significantly higher in the patient group (p<0.001). The mean mite count (31.31/cm2), in the patient group was also significantly higher than the control group (1.08/cm2), (p<0.001). Demodex spp. density was 38.94/cm2 in patients receiving chemotherapy and 7.50/cm2 in patients not receiving chemotherapy, and the difference between them was statistically significant (p<0.001). Conclusion: In conclusion, our study showed that patients with hematological cancer were infected with Demodex spp. more than controls and that the density of Demodex spp. was significantly increased in chemotherapy group. It should be kept in mind that Demodex spp. increases with weakening of the immune system and may cause skin lesions in hematologic cancer patients, especially in chemotherapy receiving patients.

Automated determination of chest characteristics of Indonesians as the basis of chest dosimetrical phantom design

Abstract Purpose: The purpose of this study was to develop software to automatically measure the main areas of the chest, i.e. soft tissue, bone, and air and to implement it in Kraton Regional General Hospital for designing a specific dosimetrical phantom for chest digital radiography (DR) examination. Methods: This study was a retrospective study on all DR images from 2015 to 2019, and computed tomography (CT) images of 102 patients in Digital Imaging and Communications in Medicine (DICOM) format files scanned from January-December 2019 at the Kraton Regional General Hospital. We evaluated the number of basic DR chest examinations compared to all DR radiological examinations. We developed a MatLab graphical user interface (GUI) for automated measurement of the areas of the main chest components (soft tissue, bone, and air). We computed the areas of the main components of the chest in order to develop a specific chest phantom for DR in the hospital. In order to compute the areas of the main components, we used chest CT images of patients with clinical indications of chest tumors. Results: The basic DR chest examination comprised 59.5% of all DR examinations in the hospital during 2015-2019. The average areas of soft tissue, bone, and air within the chest in all patients were 331, 20, and 125 cm2, respectively, with values of 345, 23, and 139 cm2 for males, and 309, 15, and 103 cm2 for females. The areas were also dependent on age with values of 121, 10, 55 cm2 for patients aged 5-11 years, 371, 27, and 88 cm2 for patients aged 12-25 years, 322, 22, and 131 cm2 for patients aged 26-45 years, and 334, 19, and 126 cm2 for patients &gt; 45 years old. Conclusion: A GUI for computing the main composition of the chest was successfully developed. The areas of chest male patients were greater than female patients. The areas of soft tissue, bone, and air were dependent on the patient’s age. Therefore, the design of dosimetrical DR phantom must consider the gender and age of the patient.

Comparison of visceral fat area measured by CT and bioelectrical impedance analysis in Chinese patients with gastric cancer: a cross-sectional study

ObjectivesBioelectrical impedance analysis (BIA) is a simple and inexpensive method to estimate body composition. However, the accuracy of BIA is unknown. We aimed to assess the accuracy of BIA in...

Évaluation de l’incidence des lésions de radiodermite en cardiologie interventionnelle

PurposeThe percutaneous coronary interventions use large doses of ionizing radiation, particularly when treating complex lesions. The incidence of radio-induced skin lesions is poorly known. Our goal was to evaluate the frequency of occurrence of such lesions, as well as the factors that may contribute to a high radiation dose. The recommended DAP (dose-area product) cutoff for skin monitoring after percutaneous coronary interventions is 500Gy cm2. Patients and methodWe prospectively studied the incidence of acute (after 5–7 days) and subacute (after 7 days to 6 months) skin lesions following angioplasty with a dose-area product (DAP) ≥200Gy cm2 in patients who underwent coronary angioplasty in our center in 2013. ResultsNine hundred and thirty three consecutive procedures were analyzed, of which 102 with a DAP ≥200Gy cm2. Three patients presented an acute lesion. Two of these three patients also had subacute lesions. Another patient presented only a subacute lesion. 4.82% (95% CI: [0–10]) of the patients with a DAP ≥200Gy cm2 developed radiodermitis lesions, or 0.47% (95% CI: [0–0.9]) of all the patients who underwent angioplasty.The Body Mass Index and the elective (as opposed to energy) procedures were independently associated with a procedure with a DAP ≥200Gy cm2. ConclusionRadiodermatitis lesions occur for 4.82% of patients benefiting from procedures with a DAP ≥200Gy cm2. We suggest the establishment of a DAP threshold for dermal monitoring of patients of 200Gy cm2 per procedure instead of 500Gy cm2.

Ultrasound assessment of rectus femoris muscle in rehabilitation patients with chronic obstructive pulmonary disease screened for sarcopenia: correlation of muscle size with quadriceps strength and fat-free mass.

To determine the relationship of the size of the rectus femoris muscle, assessed by ultrasonography, with parameters of muscle strength and body composition that are commonly used in the case-finding of sarcopenia in rehabilitation patients with chronic obstructive pulmonary disease (COPD). Cross-sectional pilot study of 18 men with severe COPD and 17 healthy controls. cross-sectional area, thickness, and width of the non-dominant rectus femoris muscle obtained by ultrasound, muscle strength determined by voluntary maximum isometric contraction of the quadriceps muscle, and fat-free mass assessed by bioimpedance analysis. Ultrasounds detected differences in the size of the rectus femoris muscle: cross-sectional area was 4.3 (SD 1.05) cm2 in patients, compared to 5.6 (SD 1.25) cm2 in controls; patients also presented lower quadriceps strength, and fat-free mass index. Cross-sectional area of the rectus femoris muscle showed a moderate correlation with quadriceps strength (R = 0.497, p = 0.036) and fat-free mass (R = 0.584, p = 0.011). In a multivariate linear model adjusted for age, body mass index,fat-free mass and muscle size, muscle strength was 7.44kg lower (p value = 0.014) in patients, compared to controls. A causal relationship was observed between the cross-sectional area of the rectus femoris muscle, assessed with ultrasonography, and maximum isometric strength of knee extension in COPD rehabilitation patients. Reduced cross-sectional area was also associated with loss of fat-free mass. Muscle ultrasound and bioimpedance analysis provide complementary and relevant information that could be useful in the case-finding of sarcopenia in COPD patients.

Moderate Aortic Stenosis and Reduced Left Ventricular Ejection Fraction: Current Evidence and Challenges Ahead.

Moderate aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) constitute a clinical entity that has been proposed as a therapeutic target for transcatheter aortic valve replacement (TAVR). It is defined by a mean trans-aortic gradient between 20 and 40 mmHg and an aortic valve area between 1.0 and 1.5 cm2 in patients with LVEF < 50%. Retrospective data suggests a prevalence of 0.8% among patients referred for echocardiographic assessment. These patients are younger and show a higher frequency of previous myocardial infarction than those with severe AS randomized to TAVR in recent trials. In two retrospective studies including patients with moderate AS and reduced LVEF, a one-year mortality rate of 9 and 32% was reported, the latter in patients treated with medical therapy only during follow-up. Echocardiographic diagnosis of moderate AS poses challenges as current guidelines are directed to determine severe AS, and different presentations of moderate and mild AS have been generally neglected. Thus, the nomenclature would need to be revised and a description of possible scenarios is provided in this review. Dobutamine stress echocardiography and computed tomography are promising complementary tools. Likewise, a standardized clinical pathway is needed, in which a high level of suspicion and a low threshold for referral to a heart valve center is warranted. The Transcatheter Aortic Valve Replacement to UNload the Left ventricle in patients with Advanced heart failure (TAVR UNLOAD) trial (NCT02661451) is exploring whether TAVR would improve outcomes in patients receiving optimal heart failure therapy.

Combined Mitral and Tricuspid Versus Isolated Mitral Valve Transcatheter Edge-to-Edge Repair in Patients With Symptomatic Valve Regurgitation at High Surgical Risk

ObjectivesThe present study aimed to test the clinical benefit of combined transcatheter mitral plus tricuspid valve edge-to-edge repair (TMTVR) as compared with transcatheter mitral valve edge-to-edge repair (TMVR) alone in patients with both significant mitral (MR) and tricuspid regurgitation (TR) at high surgical risk. BackgroundA growing number of patients with severe MR at increased surgical risk are treated by transcatheter techniques. Evidence suggests that residual TR remains a predictor of adverse outcome in these patients. MethodsSixty-one patients (mean age 79.5 ± 8.4 years, EuroSCORE II 8.6 ± 5.9%) underwent TMTVR (n = 27) or TMVR (n = 34). Echocardiographic and cardiac magnetic resonance imaging was performed before and after the procedure. ResultsReduction of MR was similar in patients undergoing TMTVR and TMVR. Effective regurgitant orifice area of TR was reduced from 0.51 to 0.29 cm2 in patients with TMTVR (p < 0.01), but remained unchanged after TMVR. On cardiac magnetic resonance imaging, only patients in the TMTVR group exhibited improved effective right and left ventricular stroke volume, and increased cardiac index (2.1 vs. 2.5 l/min/m2; p < 0.01). TMTVR led to superior improvement in New York Heart Association functional class, NT-proBNP levels, and 6-min walking distance as compared with TMVR. After up to 18 months of follow-up, patients with TMTVR experienced fewer hospitalizations for heart failure when compared with patients with TMVR (p = 0.02), whereas rates of death were comparable between both groups of patients. ConclusionsTMTVR appears superior to TMVR in terms of cardiac output and functional improvement early after the intervention, and improves clinical outcome up to 18 months of follow-up.

Incomplete reossification after craniosynostosis surgery-incidence and analysis of risk factors: a clinical-radiological assessment study.

OBJECTIVE One of the principles of the surgical treatment of craniosynostosis includes the release of fused bone plates to prevent recurrence. Such bone defects require a reossification process after surgery to prevent a cosmetic problem or brain vulnerability to damage. The objective of this study is to describe and analyze the radiological and clinical evolution of bone defects after craniosynostosis. METHODS From January 2005 to May 2016, 248 infants underwent surgical correction of craniosynostosis at HUiP La Fe Valencia; the authors analyzed data from 216 of these cases that met the inclusion criteria for this study. Various surgical techniques were used according to the age of the patient and severity of the case, including endoscopic-assisted suturectomy, open suturectomy, fronto-orbital advancement, and cranial vault remodeling. Clinical follow-up and radiological quantitative measurements in 2 periods-12-24 months and 2 years after surgery-were analyzed; 94 patients had a postoperative CT scan and were included in the radiological analysis. RESULTS At the end of the follow-up period, 92 of 216 patients (42.59%) showed complete closure of the bone defect, 112 patients (51.85%) had minor bone defects, and 12 patients (5.56%) had significant bone defects that required surgical intervention. In the multivariate analysis, age at first surgery was not significantly associated with incomplete reossification (p = 0.15), nor was surgical site infection (p = 0.75). Multivariate analysis identified area of cranial defect greater than 5 cm2 in the first CT scan as predictive of incomplete reossification (p = 0.04). The mean area of cranial defect in the first CT scan (12-24 months after surgery) was 3.69 cm2 in patients treated with open surgery and 7.13 cm2 in those treated with endoscopic-assisted procedures; in the multivariate analysis, type of procedure was not related to incomplete reossification (p = 0.46). The positive predictive value of palpation as evaluation of bone cranial defects was 50% for significant defects and 71% for minor defects. CONCLUSIONS The incidence of cranial defects due to incomplete reossification requiring cranioplasty was 5.56% in our series. Defects greater than 5 cm2 in the first postoperative CT scan showed a positive association with incomplete reossification. Patients treated with endoscope-assisted procedures had larger defects in the initial follow-up, but the final incidence of cranial defects was not significantly different in the endoscope-assisted surgery group from that in the open surgery group.

The Effect of Skin Sebum, pH, and Moisture on Demodex Infestation in Acne Vulgaris and Rosacea Patients.

Acne vulgaris is an inflammatory disease involving the pilosebaceous unit. Rosacea is a chronic inflammatory skin disease that affects the face in particular. This study aimed to determine if skin sebum, pH, and moisture affect the number of Demodex spp. in acne vulgaris and rosacea patients. This study focused on 30 patients each with acne vulgaris and rosacea. As a control group, 60 healthy individuals were included. In acne vulgaris patients, when compared to those with Demodex mite more than 5 /cm2 in each area, less than 5/cm2 were found to be oily, acidic, dry or very dry. However, there was no significant difference in moisture value. In patients with rosacea, the skin was acidic and dry in patients those with more than 5/cm2 Demodex mites when compared to those with demodex mite less than 5 /cm2 in patients in each of the right cheek and nose areas. There was no difference in skin oil level. The oily, acidic, dry, and very dry skin of the acne vulgaris patients and the oily, acidic, and very dry skin of the rosacea patients are factors facilitating the development of Demodex ssp.